Clinical Application Of Globulin And Albumin/Globulin Ratio In The Diagnosis Of Acute And Chronic Periprosthetic Infections

Objective:Periprosthetic infection(PJI)is the most serious complication after prosthetic arthroplasty and is one of the leading causes of joint revisions.However,due to the lack of a "gold standard" for the diagnosis of PJI,it remains challenging for clinicians to diagnose PJI.The aim of this study was to investigate the diagnostic significance of serum globulin(GLB),albumin/globulin ratio(AGR)and other biomarkers in acute and chronic periprosthetic infections.Methods:A retrospective study of 182 patients with periprosthetic knee/hip infection and aseptic loosening attending the Department of Orthopaedics,Second Hospital of Shanxi Medical University from January 2016 to March 2021,with 162 patients finally included according to strict inclusion and exclusion criteria,divided into three groups according to the time of onset and type of surgery: 20 patients in Group A acute infection group,Debridement,Antibiotic agents,and implant retention(DAIR)or phase I antibiotic cement sparing surgery and second-stage revision;36 patients in group B with chronic infection underwent one-stage antibiotic cement sparing surgery and second-stage revision;and 106 patients in group C with aseptic loosening underwent joint revision.The preoperative levels of GLB,AGR,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),platelet count(PLT),mean platelet volume(MPV),D-dimer(D-dimer),and platelet count/mean platelet volume ratio(PMR)were measured according to the 2018 MSIS criteria for the definition of periprosthetic joint infection.The Kruskal-Wallis H test was used to assess their value between the three groups,and the diagnostic value of GLB,AGR with other biomarkers in periprosthetic infections was measured using Receiver operator characteristic curve(ROC)analysis and area under the curve(AUC).Results:CRP,ESR,D-dimer,GLB,PLT,and PMR levels were significantly higher in the acute and chronic PJI group compared to the aseptic loosening group(P<0.01),while AGR and MPV levels were significantly lower(P<0.01).The AUC,sensitivity and specificity of different biomarkers were: CRP: 0.903,78.57%,88.68%;AGR: 0.899,91.07%,73.58%;ESR: 0.888,75.00%,85.85%;GLB: 0.880,91.07%,72.64%;D-dimer.0.809,78.57%,72.64%;PMR: 0.751,62.50%,80.19%;PLT: 0.736,64.29%,78.30%;and MPV: 0.682,41.07%,89.62%.Their results showed that higher levels of GLB with lower levels of AGR had better diagnostic performance for PJI.Conclusion:GLB and AGR have good diagnostic value in patients with acute and chronic PJI,and their diagnostic performance is similar to that of ESR and CRP,which are promising potential biomarkers in the diagnosis of PJI.